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Megans gall bladder and liver problems - any advice appreciated

Hello everyone.

I have been reading Cavalier Talk since before Christmas, as we have been going through hell and back regarding my baby Megans problems, but I didn't want to post anything until I had a good idea of what to post. Megan is an 8 year old black and tan. She may be 9, but we are not sure as she was a 4 year old rescue pup, when we got her. She is very small, and was massively overweight when we got her, but we put her on a strict Burns Diet, and within six months she turned into a gorgeous svelt and healthy girl. Luxating Patella in the first year apart, she has been very very well over the last three years but before Christmas we started to see symptoms that things were not right. Excessive drinking, runny poo, and little puddles in the house (she will have been mortified to do this as she is very well house trained). The final straw was being off her food (unknown as megan is a very greedy dog), and a very bloated tummy one evening and wheezing when we picked her up. So straight to the vets.

A very very long story short - her tests were all over the place - excessively high in some areas, very low in others, and their scans showed 'funny' things. We went from the possibility of liver disease, to a possible tumour, to everything appears healthy but her gall bladder is in the wrong place and has 'grains' in it etc., and in the end we were referred to a specialist vet in Solihull called Willows.

This Friday they discovered that she had lots of gall stones, and they strongly suggested that we had her gall bladder removed, and at the same time they would take a biopsy of her liver. Gall bladder op went well, and megan is responding very well, and we think she can come home tomorrow. They feel her quality of life will be massively improved now that the gall bladder has gone.

BUT - (there is always a but) her liver is another thing. The surgeon said he had never seen a liver like it, and he thinks it is congenital. She has been surviving on only two liver lobes. One is very very small, the other is very very large. neither of them look healthy. They have taken a biopsy of both, and the results should be back within five days.

The surgeon is a liver specialist and says he is intrigued by what he saw, and needs the results to give us an idea what happens from now on and how we manage it. As he is a liver specialist I am taking hope from the fact that he would have recognised cancer/tumour instantly probably, so the biopsy must be for something else.

So, my question is - No.1 highly unlikely but has anyone else every come across this before? and No.2 we were adapting her diet before the operation to help her liver, by giving her chicken, white rice, fish, pasta and low fat cottage cheese, (which she wolfs down) and also adding milk thistle and SamE to her meds - can anyone else suggest an easy on the liver diet? and also what sort of quantity is she supposed to be eating. She is currently 6kg weight.

Sorry, this was supposed to be a long story short, but it has turned into quite a long one, and I have missed so much out in between.

Thank you for reading and I hope someone can look at this and give me hope/help/advice.

Wow, that's quite a story for you and medical history for Megan. So sorry she has to go through this. I actually have no advice to give, but I know there are some on the board who have had to handle liver issues and hopefully they will see this and give some suggestions.

Good luck and please come back and let us know how Megan is and the results of the biopsy.

Tommy who died in November had kidney disease and pancreatitis so finding a diet that was suitable for him was very difficult.
I was referred to Marge Chandler, a veterinary nutritionist at the Royal ( Dick ) School of Veterinary Studies Nutrition Service in Edinburgh. The results of Tommy's tests were sent by email and she devised a home cooked diet for my lovely old boy.

Unfortunately there were many other setbacks for Tom and I eventually had to make the final decision to let him go but at least I knew I had given him every chance I could.

My understanding is there are only two qualified Veterinary Nuritionists in the UK. It may be worth asking your Surgeon if he will refer your little girl.

Margaret C

Cavaliers......Faith, The Ginger Tank and Woody.
Japanese Chins.... Dandy, Benny, Bridgette and Hana.
Remembered with love......... Tommy Tuppence and Fonzi

Hello there, thank you for your replies.
This morning at 6am Megan had a seizure at home. As she has never had one before, we called the emergency vet immediately and took her to surgery straight away. (She was flailing around, limbs stiff, and she wee'd as she was doing this - it probably lasted about two minutes in its intensity). Her limbs were still quite stiff by the time we got to the vets, but she had calmed down a bit. By the time we left her there, she had started to soften up a little, and was moving her front paws by herself, but she still had a bit of a head tilt. Her eyes, gums and belly all looked very pale, almost pale yellow. We have just had a call from the vet (7:30am) to tell us that she is now starting to snooze, that her head tilt has gone, that the blood tests showed that her ALB and Bilirubin still looked high post op, and that they are now waiting for Jane (the head medical at Willows in Solihul) to get into the surgery at 8am, when they can give her a call.
We are just waiting for another call so we can go back.Not sure what we can do now.
Thanks,
Lynne

10:45am Tuesday 15th. Just called the vets as they hadn't been in touch, and they have told me that megan has had another seizure since we left her first thing this morning, exactly the same as the first, from our description. Thankfully she was in the right place, as she has come out of it well, and is again snoozing. They have given her Diazapan, so they say she won't have another seizure. Although they are still waiting for the specialist vet to get in touch, they are sure that the problem is liver related, and seeing as her liver is so unusual, it may not be as straight forward. I have just given the specialist vet a call myself to try and give them a nudge but she is in appointments, so I have logged my message as urgent. Everything I have read on seizures so far this morning tells me that they are mostly managed with the right meds and diet, but I am worried and scared that my little megan can't take all this so soon after her gall bladder op, and as the liver biopsys are not due back until Friday, there is nothing to help the vets as yet. If anyone has experience of seizures could they please take a little time to give me a little pep talk please?
Many thanks
Lynne

No experience of seizures, but do hang in there and try not to worry too much -- save your energy for her . Chances are things WILL be manageable.

I learned this when dealing with my dogs with SM, after I spent months very upset over one dog prior to an MRI. It turned out he was totally clear for SM and clear again 4 years later on a second MRI -- and it was his then-asymptomatic half brother who had a syrinx on that first MRI visit. I felt like I'd expended so much in worry, needlessly, and over the wrong dog! It's so much better to try as best as possible to aim towards getting all the info you can but not making any assumptions til you have further tests results. I know how hard it can be as your mind races to think of all the possibilities. I think it is most productive to be as informed as possible by doing background reading, so you feel ready and able to ask questions, and so you have in mind some possible scenarios for the future -- without getting overly concerned about and attached to any of them until you have more information from doctors. And even with a worrying diagnosis you'd be surprised how well an individual dog can do sometimes. I had a severe MVD rescue girl live very cheerfully for three years when she should have had more like 6 months. They can really amaze us.

Hi Karlin,
Thank you so much for that message - it means a lot that someone can talk to me, and give me a different perspective to my vet (s) and my husband. I have just read out your words to him, and he feels better having heard them. The specialist vet has been in touch and is going to keep an eye on proceedings at my local vet and ring me later in the afternoon once she has spoken to them again. Also, local vet has been in touch again - no more seizures since the 8:30am one, and they are hoping to be able to get some results from the liver biopsy today as they have both escalated it as an emergency, so we may get feedback and a way forward sooner than later. They may keep her in overnight, and although Im upset I can't be with my little girl, I know she is better off being with people who know what to do, if she does go downhill again. Yes Geeky husband has spent all morning on the internet learning what he can about seizures post op, general, and anything similar so that we can be ready for whatever comes next. I am very much in two places at once - I want to know, but I dread the knowing, and I just want her home again. I'll update once I have a little more information, and thank you once again.
Lynne x

This is a serious situation - read up on dog hepatic encephalopathy as this is most likely the cause of the seizures from what you have described (jaundice, high bilirubin, and I presume that you meant to say low albumin, not high). You can search here on the forum as Sins had a Cavalier with this, and I recall that there is much information on those threads. I have info on my home computer that I saved after I compiled some info for her, but I won't be home until tonight. Don't take the time to read up on seizures in general because this won't be applicable for hepatic encephalopathy.

Did you discuss the possibility of PSS - portosystemic liver shunt - with the specialist? This is a congenital (present at birth) defect that can be corrected by surgery, but the surgery is usually done when the dog is very young. The biopsy would be definitive for cancer or other problems - just looking doesn't really rule these things in or out.

It is excellent that they removed her gall bladder. Gall bladder rupture is not uncommon, and the results can be fatal, so I'm very glad to hear that this possibility is now gone.

I can give you a lot of information about diet, supplement, lactulose, etc., but it sounds as if your specialist is doing all of the right things. Let's wait until you know more. Dr. Jean Dodds (in the US) has a lot of good info on the web, and Dr. Donald Strombeck also has a great site about home cooking for particular diseases. This is something you can easily do at home.

Best wishes, and you and Megan are in my thoughts and prayers,

Pat

P.S. Just read the link I gave and learned that PSS can also be acquired - I did not know that before now.

Thanks Pat, much appreciated. The specialist vet is ringing us later this afternoon (hopefully with the news that the results from the liver biopsy have come through) so I shall flag that up with her. We have just had a look at hepatic encephalopathy on the link you gave, she has only had the increased thrist, urination and now the seizures from the list of possible symptoms. Would they have been able to see if we were dealing with a pss on the (many) scans possibly? Or is it not easy to see that way? I picked up one of your earlier posts regarding Dr. Dodds, and so thats where i learned about white food i.e. pasta, chicken, fish, white rice, cottage cheese etc., Im just not sure about quantity for her, but that is something I can hopefully worry about another time. I'll definately have a look at Dr. Strombecks home cooking site too - Im sure that is the way to go.
We have just had a call from the local vet who say she is looking brighter and happer than this morning (not difficult), and was tail wagging. She has had lactulose to absorb any amonia, and is also on a drip to flush out anything else.
So, really we are now waiting for the specialist vets phone call, the results, and hopefully a plan of action.
All the best
Lynne.

Thanks Pat, much appreciated. The specialist vet is ringing us later this afternoon (hopefully with the news that the results from the liver biopsy have come through) so I shall flag that up with her. We have just had a look at hepatic encephalopathy on the link you gave, she has only had the increased thrist, urination and now the seizures from the list of possible symptoms. Would they have been able to see if we were dealing with a pss on the (many) scans possibly? Or is it not easy to see that way? I picked up one of your earlier posts regarding Dr. Dodds, and so thats where i learned about white food i.e. pasta, chicken, fish, white rice, cottage cheese etc., Im just not sure about quantity for her, but that is something I can hopefully worry about another time. I'll definately have a look at Dr. Strombecks home cooking site too - Im sure that is the way to go.
We have just had a call from the local vet who say she is looking brighter and happer than this morning (not difficult), and was tail wagging. She has had lactulose to absorb any amonia, and is also on a drip to flush out anything else.
So, really we are now waiting for the specialist vets phone call, the results, and hopefully a plan of action.
All the best
Lynne.

Seizure in the presence of liver disease is the classic sign of hepatic encephalopathy, so you don't need to see the entire list of symptoms. And yes, you would expect to see PSS on ultrasound, but from what you've reported, this sounds like a complicated case. If I could see the reports I may understand more, but then again I have a hard time translating UK blood chemistry values since they are different from US values (which are burned into my brain!). Very low albumin is serious - that can result in ascites (the abdominal bloating from fluid leaking), and the high bilirubin indicates primary liver disease (whereas elevated liver enzymes can be the result of lots of different things). Jaundice is also a significant symptom of primary liver disease. She may also be anemic because of red blood cell problems caused by the malfunctioning liver. There are lots of different liver diseases -

but let's get more information before you read about anything and everything. Make note of the gallbladder mucocele in the above link. I wish you had learned about diet from your vet instead of a post on CT, but glad to hear about the lactulose, milk thistle and SAM-e. Dr. David Twedt is the US veterinary "liver guru," and I've got lots of source material from him. But again, let's wait and see what you learn rather than wasting your time reading material that is not relevant. I know you want her home, but hospitalization is a good place for her right now.